International Journal of Esthetic Dentistry (EN), 02/2020

A digital smile diagnosis based on Digital Smile Design (DSD) concepts reinforces the predictability and precision of orthodontic and multidisciplinary cases as it allows more accurate planning from an esthetic point of view. The intention of this clinical case series was to verify the relationship between the ideal and adapted smile in three orthodontic multidisciplinary cases treated using the Invisalign system in order to have a better understanding of the correlation between the several smile components. The ideal smile construction requires face, lips, gingival tissue, and tooth analysis and evaluation, as well as the appreciation of how all these aspects occur together. When the ideal smile line is not achievable in difficult clinical situations, the treatment goal would be an adaptation to the same line that supports a more predictable movement range. These DSD and orthodontic concepts should be primarily applied, since all intermediate involvement, as well as the final outcomes, are essentially planned from the beginning in clear aligner treatments. The presented case series allowed the authors to understand the importance of these digital diagnostic tools in dealing with certain particularities in orthodontic clear aligner treatments, both at the beginning and during the refinement/finishing stages.

Background: The lightness of teeth and the distances of the upper and lower lip from the maxillary cervical and incisal lines are factors that correlate with smile attractiveness. Purpose: This study investigates the degree of association of the above factors with smile attractiveness and evaluates the possible effect of evaluators' gender, age, occupation, and education level on the perception of smile attractiveness. Materials and methods: An almost perfect smile of an adult Caucasian female was altered to create various smile images with differences in lightness of teeth and upper and lower lip positions. The images were randomly assembled in three slides of four, seven, and five images each and presented to 130 participants to evaluate the most attractive smile (MAS) and the least attractive smile (LAS). Data collected were analyzed for differences between gender, age, occupation, and education level as regards the evaluation of the MAS and LAS using the chi-square test with a significance level of α = 0.05. Results: Statistical analysis showed that the smile images in L1 and L2 were equally considered to be the most attractive smiles. The chi-square test indicated no differences between all groups (P > 0.05). Percentages for the most attractive smiles for the lower lip positions were almost equal for most positions of the upper lip, with differences only between age groups (P > 0.05). The least attractive smiles were those with the upper lip position at 3 mm above the cervical line, with differences only between occupation groups (P 0.001). Conclusion: The results of this study indicate that lightness of teeth positively affects smile attractiveness. Lower lip positions with a distance of 0 to 1 mm from the maxillary incisal line are considered more attractive. Upper lip distances were strongly associated with smile attractiveness. Gender, occupation, and education level did not differently affect the perception of attractiveness due to lower lip positions, but age did.

Introduction: An attractive smile helps people to feel more self-confident and look younger and more attractive. Smile evaluation and smile design are therefore important aspects of restorative and orthodontic diagnosis and treatment planning. Aim: The purpose of this study was to determine the influence of tooth size on smile attractiveness. Materials and methods: The study was conducted in 2017 in Sanandaj, Iran. The participants were selected by convenience sampling among 50 dental students, 50 art students, and 50 laypeople. A color photograph of a posed smile was chosen from the internet. The maxillary anterior dentition was digitally altered to produce different tooth sizes with width-to-height ratios of 65%, 70%, 75% (original photograph), 80%, 85%, and 90%. Six images of each subject were paired into 16 possible combinations and presented to three groups (dental students, art students, and laypeople). The Wilcoxon signed-rank test was used for data analysis. Results: Statistical analysis showed that the width-to-height ratios of 65% and 70% for the maxillary anterior teeth was considered least attractive by the participants in all three groups. Conclusion: Minimal tooth size should be taken into account during restorative treatment planning, and excessive tooth proportions should be considered esthetically problematic.

Background: Gingival tissue circumforaneous to the maxillary anterior teeth has been known to play a crucial role in smile esthetics. Reports in the literature suggest that both tooth and gingival display in the premolar areas are relevant for a beautiful smile. The present study examines the amount of tooth and gingiva exhibited in relation to the gingival smile line (GSL) and the interdental smile line (ISL). Materials and methods: The study population comprised 120 periodontally healthy patients within an age range of 20 to 40 years who were equally divided into two groups based on gender. The gingival zenith position (GZP), gingival zenith level (GZL), presence or absence of interdental papillae, GSL, and ISL were determined for the maxillary anterior teeth up to the second premolars. Results: The mean GZL for the second premolars was found to be highest, followed by that for the first premolars and the lateral incisors. The GZL for female patients was slightly higher than that for males. The difference between the GZL for the first and second premolars in both the males and females was statistically significant (P 0.0001). The majority of participants – 36 (60%) of the males and 33 (55%) of the females – displayed first premolars, whereas both the premolars were visible in 18 (30%) males and 22 (36%) of the females. Conclusions: Within the smile corridor, the majority of participants exhibited tooth and gingival display in the maxillary anterior teeth and premolar region. The GZL was greatest for the second premolars and smallest for the lateral incisors, indicating a considerable amount of gingival tissue display during smile for both GSL and ISL.

The permanent maxillary canine is the second most frequently impacted or displaced tooth. The standard treatment for an impacted canine includes, among other things, surgical exposure and orthodontic alignment. Surgical techniques for this procedure vary depending on whether the tooth is labially or palatally impacted, while orthodontic techniques vary according to clinical judgment and experience. Autotransplantation is a treatment alternative for impacted canines with complete root formation. The success of tooth transplantation depends on the vitality of the periodontal ligament (PDL) attached to the donor tooth, and its viability decreases when it is exposed extraorally. This article reports on maxillary canine autotransplantations combined with connective tissue grafts (CTGs) and orthodontics. The recipient mesiodistal space was created orthodontically and the recipient socket was prepared using dental implant drills. Following transplantation, bone defects were grafted using guided bone regeneration (GBR). At 4 years post-transplantation, the soft tissue level was stable and periapical radiographs showed a practically normal contour of the alveolar crest around teeth 13 and 23. The two permanent canines presented no root resorption and ankylosis, and no signs of inflammation or bleeding were observed. The procedure used in this case report demonstrates that canine transplantation combined with GBR, plastic surgery procedures, and orthodontic treatment may yield acceptable and predictable esthetic results.

Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient's own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket-shield technique at immediate implant placement and provisionalization for single-rooted teeth.